When an elderly loved one in San Diego requires nearly constant medical care, many family members are at their most concerned when that loved one has to be hospitalized. However, according to arecent article in California Healthline, one of the most dangerous periods forelderly patients actually starts after they leave the hospital, and perhaps not for the reasons you might think. The problem is not that the elderly person does not receive sufficient care after a hospital visit, but rather that the patient failed to receive proper care while in the healthcare facility. Does this rise to the level ofelder neglect?

Problems Associated with Poor Transitional Care

The time between leaving the hospital and receiving care either from a home caregiver or staff members at a nursing home in Southern California is known as a period of “transitional care.” As Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine explains, “poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs.” While “the most risky transition,” Arbaje explains, “is from hospital to home with the additional need for home care services,” since it is the type of situation about which the least is known, injuries resulting from poor transitional care can also happen when the patient goes from a hospital to a local nursing home.

If you have an elderly loved one in a San Diego nursing home, should the prevalence of sex offenders within the facility impact how you gauge your relative’s personal safety and risk ofnursing home abuse? We are not referring to convicted sex offenders who are working at nursing homes or assisted-living facilities, but rather convicted sex offenders who themselves are seniors and require attention in a facility designed for the elderly. Do such situations increase the likelihood ofelder sexual abuse in the nursing home setting?

Notifying Nursing Homes About Residents on the Sex Offender Registry

Arecent article in the Dayton Daily News raised this question, pointing out that in California the law requires the Department of Corrections or another agency to notify the nursing home if a person who is listed on the sex offender registry plans to move into a care facility. In the event that a government agency does not report this information, it is up to the offender to self-report that she or he is on the sex offender registry. In addition, nursing homes in San Diego and across the state are required to “notify all residents and employees,” according to the article. But are those steps sufficient to protect other residents from the risk of elder sexual abuse? On a related note, does the risk of being a victim of elder sexual abuse increase when an elderly person on the sex offender registry moves into a nursing home?

Law enforcement officials are often in a unique position to recognize signs and symptoms ofelder abuse in the San Diego area. Yet, as anarticle from In Public Safety points out, police officers frequently are not sufficiently trained in recognize nursing home abuse and neglect, and as such they inadvertently miss the symptoms that could help to prevent future injuries and, in some cases, deaths. Sincenursing home abuse cases also can coincide with calls concerning assault and domestic violence, it is important for law enforcement officers to be trained to recognize the signs of elder abuse.

One of the first things we can do, the article suggests, to change the ways in which police officers evaluate whether someone has been the victim of elder abuse is to require specific training about nursing home abuse and neglect. In our state, the California Department of Social Services (CDSS) does have requiredtraining for mandatory reporters, but not all law enforcement officials understand the extent of elder abuse in the community and the ways that we can work together to help prevent it.

If an elderly San Diego County resident who has sustained injuries as a result ofnursing home abuse ends up in an emergency department, will he or she be properly diagnosed with injuries caused byelder abuse? According to arecent article in Psych Central, formal diagnoses of elder abuse are made in only one out of every 7,700 visits to emergency rooms across the country. This information comes from a new study conducted by researchers at the University of North Carolina at Chapel Hill, the University of California San Diego, and Weil Cornell Medicine.

Given what we know about rates of elder neglect and nursing home abuse—afact sheet from the National Council on Aging (NCOA) predicts that about 10% of all Americans aged 60 and older have been subject to some form of elder abuse—the notion that only about .01% of seniors who seek treatment in emergency departments are diagnosed with injuries caused by elder abuse seems startling. What else does this study teach us, and what can we do to help?

Can nursing homes and assisted-living facilities in Chula Vista and Escondido do more toprevent wandering among dementia patients? According to arecent article in McKnight’s Senior Living, “wandering and elopement are among the oldest challenges senior living communities face.” While incidents of wandering often do not lead to any serious harm, in some cases, seniors who do not have proper supervision can sustain severe and even fatal injuries as a result of wandering from the facility. Typically, cases of wandering and elopement involve patients who are suffering from dementia.

Given that wandering often results from limited staffing that may rise to the level ofnursing home neglect, certain innovators have begun to imagine ways in which technology might be able to help. As the article discusses, technological innovations, such as radio frequency and real-time location devices, as well as behavior-tracking tools, can allow facilities to track residents and to prevent them from wandering outside the facility.

California law has proven to be a step ahead of federal law when it comes to banningarbitration agreements in nursing homes in order toprevent elder abuse. A recent Medicare final rule has banned nursing homes “from requiring patients to agree to mandatory arbitration prior to admission,” according to anarticle in Bloomberg BNA. Anotherarticle in The New York Times emphasized the importance of this new rule. When the Centers for Medicare & Medicaid Services (CMS) released news of the final rule on September 28, San Diego nursing home residents already were protected against mandatory arbitration agreements undersection 1599.81 of the California Health & Safety Code.

Yet the Medicare final rule still has relevance for San Diego residents. First, anyone living in Southern California who has elderly loved ones in another state now can be assured that those seniors, too, are protected against mandatory arbitration agreements. In addition, the new Medicare final rule also does more than protect against mandatory arbitration agreements, and those additional requirements will apply to elderly residents of nursing homes and assisted-living facilities in the San Diego area.

How California Law Compares to CMS Final Rule on Arbitration Agreements

Nursing home abuse is a serious problem in San Diego. For a number of years, elder safety advocates have been looking for new ways to prevent nursing home abuse, as well as to properly identify it when it does happen. According to arecent article from USC News, “doctors, first responders, and other health care professionals can use techniques inspired by law enforcement to better identify and address cases of elder abuse.” This new methodology for detectingnursing home neglect arose from a clinical study at USC’s Leonard Davis School of Gerontology.

When we say that healthcare providers and emergency responders should take a cue from law enforcement when looking for signs and symptoms of elder abuse, what, precisely, do we mean? In short, the study suggests that a “forensic lens” approach can help those not trained in law enforcement to determine where there is “cause to believe neglect or abuse [has] taken place.”

How broad is the termnursing home neglect? For instance, when a senior has a problem with drug or alcohol abuse and lives in a nursing home or an assisted-living facility in Southern California, does the facility have a duty to prevent the senior from obtaining potentially harmful substances? And if the facility knows about a history of drug or alcohol abuse and does not take precautions to limit a senior resident’s access to alcohol or prescription drugs, can the nursing home be responsible for injuries that occur? According to afact sheet from the National Council on Alcoholism and Drug Dependence (NCADD), it can be difficult to recognize signs and symptoms of substance abuse among older adults.

Should we be able to expect that facilities will look into signs and symptoms of substance abuse among elderly residents? And if a facility in San Diego already knows that one of its residents has a history of drug or alcohol abuse, what must it do differently in other to avoid allegations ofnursing home negligence?

When you have a loved one residing in a San Diego nursing home, it is extremely important to think about how the facility is managingfall risks. According to afact sheet from the Centers for Disease Control and Prevention (CDC), millions of seniors suffer injuries from falls each year, and about 25% of the elderly population will fall in any given year. As the CDC points out, about 20% of those falls among seniors result in serious injuries such as a traumatic brain injury (TBI) or broken bones. More than 800,000 older adults require hospitalization because of a fall-related injury each year, and around 300,000 seniors need to be hospitalized specifically because of a hip fracture. All in all, approximately 2.8 million elderly adults are treated in emergency departments each year due to falls. Of those seniors who get hurt, about 1,800 die as a result of their injuries.

Since falls are so common among older adults, and given that they often result in serious injuries, what should nursing homes do to help prevent falls from happening? If nursing facilities in San Diego do not take proper precautions when it comes to fall prevention, can they be liable fornursing home neglect?

Is the quality of life improving for Southern California residents in assisted-living facilities? And if so, how much attention do we need to pay to the risks ofnursing home abuse and neglect in these communities if a majority of seniors say they are content? According to arecent article in McKnight’s Senior Living, “residents of assisted living communities in California are very satisfied with their living situations” on the whole. While this is good news for many elder justice advocates in the state, we should not let it obscure the fact that there remain a number of seniors who are not satisfied with their living situations and who become victims ofelder abuse.

Although the recent article presents promising data on elderly assisted living in the state, we still need to consider the risks to California seniors who do not fall into this depicted majority.

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